Is lymphocytic thyroiditis a unique type or merely a type of Hashimoto's thyroiditis?

AIM: Objective of the study was to clarify the role of apoptosis in the pathogenesis of lymphocytic thyroiditis (LT) and the existence of difference between Hashimoto's thyroiditis (HT) and LT. METHODS: We evaluated levels of antithyroglobulin and antithyroperoxidase antibodies, the apoptosis by in situ Cell Death Detection-TUNEL and the expression of Bcl2 and Bax by immunohistochemistry in thyroid tissues from 16 patient with HT, 10 with LT and 10 with euthyroid goiter-EG (control group). RESULTS: It was found that apoptosis of thyrocytes in HT (mean 3.05%, SD 1.29%) and LT (mean 2.70%, SD 1.17%) was statistically significantly higher than EG (mean 0.56%, SD 0.23%), but the difference in the percentage of thyrocytes between HT and LT was not statistically significant. In HT the percentage of apoptotic infiltrating lymphocytes (mean 0.59%, SD 0.23%) was smaller than in EG (mean 2.26%, SD 1.42%), but it showed no significant difference in comparison to LT. The expression of Bax in infiltrating lymphocytes in HT (mean 0.72%, SD 0.34%) was statistically significantly higher than LT (mean 0.11%, SD 0.06%). The level of thyroglobulin was lower in HT compared to LT (P<0.01) and compared to EG (P<0.01). The level of antithyroglobulin/antithyroperoxidase antibodies was higher in HT compared to LT (P<0.01) and compared to EG (P<0.01). There was no statistically significant difference in the level of thyroglobulin and level of antibodies between LT and EG. CONCLUSION: These results suppose that apoptosis represents one of significant mechanisms in the pathogenesis of both HT and LT and that LT probably differs from HT.

The predictive value of the presence of different antibodies and thymus pathology to the clinical outcome in patients with generalized myasthenia gravis.

OBJECTIVES: To analyze the predictive value of anti-acetylcholine receptor antibodies (anti-AChR Ab) and anti-muscle specific kinase antibodies (anti-MuSK Ab), as well as the thymus pathology to the clinical outcome in patients with generalized myasthenia gravis (MG). METHODS: We analyzed 138 patients with generalized MG, who were thymectomized and assayed for anti-AChR Ab and anti-MuSK Ab. RESULTS: Anti-AChR Ab were detected in 84% of patients, while anti-MuSK Ab were present in 36% of the AChR Ab negative patients. Severe forms of the disease were more frequent in MuSK Ab positive, compared to the AChR Ab positive and complete seronegative patients. Thymic lymphoid follicular hyperplasia (LFH) was present in 60%, thymoma in 23%, atrophic thymus in 9% and the normal thymus in 8% of patients. LFH was more frequent among women, while thymoma and atrophic thymus were more frequent in men. The younger patients mainly had LFH and normal thymus, while thymoma and atrophic thymus were more frequent in older patients. The mildest clinical presentation was present in patients with normal thymus, while severe forms of the disease were registered in the patients with thymoma. The AChR Ab positive patients had more often LFH and thymoma, while within MuSK Ab positive patients atrophic thymus was most common. CONCLUSION: The best disease outcome was observed in patients with normal thymus or LFH with anti-AChR Ab or without both types of antibodies.

Transverse stability of solitary waves propagating in coupled nonlinear dispersive transmission lines.

In the semidiscrete limit and in suitably scaled coordinates, the voltage of a system of coupled nonlinear dispersive transmission lines is described by a nonlinear Schrödinger equation. This equation is used to study the transverse stability of solitary waves of the system. Exact results for the growth rate and the corresponding perturbation function of linear transverse perturbations are obtained in terms of the network's and soliton's parameters.

Aneurysm of the inferior vena cava: case report and review of the literature.

Aneurysms of the inferior vena cava (IVC) are extremely rare. To the best of our knowledge, only 29 cases of IVC aneurysms are published in literature. We present a new case of surgically treated symptomatic saccular aneurysm of the infrarenal IVC and review previously published cases. Following resection of the aneurysm and the thrombosed infrarenal IVC, the patient fully recovered. Thrombosed IVC aneurysm may mimic a retroperitoneal tumour. In some cases, CT and MRI findings may be equivocal. Surgical treatment is indicated in all symptomatic and low-risk asymptomatic cases.

Heart and renal failure in renovascular hypertension caused by giant cell arteritis--case report.

We report a case of a male teenager with severe heart and acute renal failure as the dominant clinical manifestations of renovascular hypertension (RVH) caused by atypical giant cell arteritis (GCA). Unrecognized RVH and treatment of the consequent heart failure by angiotensin-converting enzyme inhibitors (ACEI) probably contributed to progression of renovascular disease to bilateral renal artery occlusion. Recurrent "flash" pulmonary edemas could not be prevented until surgical revascularization of the only functioning right kidney was achieved by an aortorenal bypass. Prompt post-operative normalization of heart function and arterial hypertension occurred despite the histopathological finding of the resected renal artery compatible with GCA and 4-year duration of significant renovascular disease. At the last check-up, the patient was asymptomatic, with normal arterial pressure on the prescribed treatment: carvedilol, hydrochlorothiazide, prednisolone 20 mg daily and aspirin. Subsequent follow-up is necessary to observe the evolution of GCA as an exceptionally rare cause of RVH.

Papillary carcinoma in a thyroglossal duct cyst.

Papillary carcinoma arising in a thyroglossal duct cyst is a rare tumor. We report the case of 64-year-old man treated for thyroglossal duct cyst. Preoperatively, the thyroid gland was normal on physical examination and imaging studies. The Sistrunk procedure was done. The histopathological examination revealed thyroid papillary carcinoma. Postoperatively thyroid hormon was given to suppress serum TSH levels and the patient was followed at regular intervals. During a 5-year follow-up period, no recurrence of the disease occured.

Takayasu's aortoarteritis.

Surgical treatment of two female patients aged 32 and 41 years, with neurological problems causes by type I Takayasu's aortoarteritis, are presented here. Both of them were treated with by pass from ascending aorta to left common carotid and left subclavian arteries, using transsternal approach. During the follow up period (3.5 years for the first, and 2 years for the second patient) both patients were free of neurologic symptoms. Corticosteroid therapy was given to the first patient for controlling of active diseases, immediatelly after the operation and during the first three postoperative months. By this reason an infection af the proximal part of sternal wound was developed. MRI showed involvement of the vascular graft. Due to high risk of reoperation, medical treatment was performed. Takayasu's aortoarteritis is very unsommon in our country, as well as in other countries which don't belong to Far East. In cases with hemodinamic important arterial lesions produced disabling symptoms, a standard PTA and reconstructive vascular procedures are indicated. Takayasu's aortoarteritis is a complex disease. It requires combined dignostic and therapeutic approaches which produce satisffied long-term results.

[Rational diagnosis and surgical treatment of solitary thyroid nodules]. / Racionalna dijagnoza i hirursko lecenje solitarnog nodusa stitaste zlezde.

Few subjects in endocrine surgery have generated as much controversy as the management of thyroid nodule. The controversial issues include evaluation of laboratory findings and imaging diagnostic procedures in the patient with solitary thyroid nodule. The major issue in relation to controversies is choice of optimal diagnostic workup.

[Cytologic evaluation of solitary thyroid nodules]. / Citoloska evaluacija solitarnog nodusa stitaste zlezde.

Fine-needle aspiration is a low-cost diagnostic tool with principal value in determining which patients with thyroid nodules should undergo surgery. Team work and close cooperation among endocrinologists, surgeons, and pathologists are essential for success. Cytologic criteria for diagnosis of the most frequent conditions (benign cystic lesions), Hashimoto thyroiditis and malignancies found in thyroid aspirates have been provided. The unsolved problem of the so-called "follicular" or oxyphilic lesion or neoplasia will be investigated by immunocytochemistry.

[Classification, staging, prognostic factors and risk factors in thyroid carcinoma]. / Klasifikacija, stepenovanje, prognosticki faktori i faktori rizika kod karcinoma stitaste zlezde.

Thyroid carcinomas arise from follicular cells (papillary, follicular, Hurthle, anaplastic), parafollicular cells (medullary) and stroma (lymphoma, sarcoma). Gradation and prognostic factors are different for every one of histological type. Most patients with papillary and follicular thyroid cancer have an excellent prognosis. At the other extreme is anaplastic thyroid cancer whose usual mean survival can be measured in months. Exposure to external radiation and living in endemic goiter area increase the frequency of thyroid cancer. Medullary thyroid carcinoma is often familial and may occur in associations with the multiple endocrine neoplasia syndromes.

[Pathohistologic and immunohistochemical characteristics of thyroid carcinoma]. / Patohistoloske i imunohistohemijske karakteristike karcinoma stitaste zlezde.

Numerous pathohistologic criteria, difficulties and pitfalls in the process of diagnosing of thyroid carcinoma are discussed. Benign hyperplastic papillae may be present in colloidal cystic goiter and hyperplastic goiter. These structures are lined by cells with normochromatic nuclei and do not disturb the thyroid tissue architecture. Papillae in papillary thyroid carcinoma have cells with ground-glass, hypochromatic nuclei. Follicles inspissated in capsula of follicular or even colloidal adenoma may be evaluated as capsular invasion--diagnostic feature of follicular carcinoma. Undifferentiated thyroid carcinoma is sometimes similar to fibrosarcoma and reveal cellular pleomorphism, anaplasia and numerous foci of necrosis. Medullary thyroid carcinoma with scanty stromal amyloid, its papillary variant and carcinoid-like histologic type consist of oval cells with eosinophilic cytoplasm and dark nuclei.

[Papillary carcinoma of the thyroid gland]. / Papilarni karcinom stitaste zlezde.

Papillary thyroid cancer is after ovarian cancer the most frequent malignant disease of the endocrine system and because of this fact, early detection and appropriate surgical treatment is essential. Radical surgical treatment lower the risk of the disease relapse and postoperative adjuvant therapy with radioiodine is possible as well as postoperative follow up with thyreoglobulin measurement. If the total thyroidectomy is performed in highly specialized institution the risk of postoperative complications is acceptable and therefore is the treatment of choice for papillary thyroid cancer. Only the patients with occult papillary thyroid cancer can be treated with hemithyroidectomy. In our series of 410 patients the majority of the patients (85.12%) were in the early phase of the disease and the degree of successfully performed radical surgery for papillary thyroid cancer was very high (tumor reduction was performed in only 1.46% of cases).

[Follicular carcinoma of the thyroid gland]. / Folikularni karcinom stitaste zlezde.

Follicular thyroid cancer is the second most common thyroid malignancy. This tumor has a predisposition for hematogenous dissemination an extra thyroid spread. Accurate cytological diagnosis of follicular thyroid cancer is not possible and this fact highlights the necessity for surgical treatment of any suspicious thyroid nodule. Aggressiveness of this tumor is greater than in the case of papillary thyroid cancer and it is the reason for radical surgical treatment of follicular thyroid cancer. Total thyroidectomy facilitates later adjuvant therapy with thyroid hormones and radioiodine. This procedure improves the outcome and the risk of relapse. Results of our study clearly demonstrate that diagnosis of follicular thyroid cancer in us is established in the early phase of the disease (78.57%), but the significant number of the patients (21.43%) is still in the advanced phase of the disease.

[Medullary carcinoma of the thyroid gland (sporadic, familial)]. / Medularni karcinom stitaste zlezde (sporadicni, familijarni).

Medullary thyroid cancer (MTC) is uncommon thyroid tumor with specific characteristics which undoubtedly divide this tumor from other thyroid malignancies. Patients with sporadic or hereditary form of MTC differ in clinical presentation, recurrence of the disease and outcome. The aim of study was to establish surgical characteristics of MTC as well as clinical factors that influence surgical treatment. The study group consisted of 68 patients with MTC managed at the Center for Endocrine Surgery between 1987 and 1999. Retrospective analysis included clinical form of the disease, general data, histological and other tumor characteristics. Mean age of the patients were 47.3 years (female/male ratio: 1.5:1). Mean size of tumor was 80.5 cm3, 72.1% patients had tumor greater than 4 cm. in diameter or extrathyroid spread. The majority of patients were in II and III stadium of the disease. Primary operation (at least total thyroidectomy) was performed in 57 (84%) patients. 2(3%) had postoperatively temporally nerve palsy and 7(10.29%) temporally hypoparathyroidism. The overall survival was 46.8 +/- 9.9% after 9 years and 63.6 +/- 7.2% at 5 years. Postoperative calcitonin value is significant predictor of survival/Spearman's coefficient (R = 0.7048)/, worse prognosis is in correlation with high postoperative calcitonin values. The treatment of choice is at least total thyroidectomy and central lymph nodes resection if enlarged lymph nodes are found. Precise operative technique lowers the risk of postoperative complications. Complex approach to the patient with MTC includes all available methods in pre and postoperative evaluation as well as surgeon's knowledge and skill.

[Anaplastic carcinoma of the thyroid gland]. / Anaplasticni karcinom stitaste zlezde.

The aim of the present paper was to study some characteristics and possibility of surgery of anaplastic thyroid cancer. During five years period in Center for endocrine surgery, we found anaplastic thyroid cancer in 65 patient (44 female and 21 male), median age 63 years (from 37 to 88 years). Surgical treatment was peerformed in one half (32) anaplastic thyroid cancer patients, at majority of them operative biopsy or tumor reduction only. Radical surgery was performed in about 10% patients. Possibility of surgery in anaplastic thyroid cancer are very limited. In one third patients there were long standing goiter or thyroid nodule or histological verified dedifferentiation of papillary thyroid cancer. This patient should be operated formerly, before anaplastic transformation.

[Lymphoma and other rare malignant tumors of the thyroid]. / Limfomi i drugi retki maligni tumori stitaste zlezde.

UNLABELLED: Primary thyroid lymphomas are rare. Surgery is seldom indicated. The aim of the study is to find out the main characteristics of primary thyroid lymphomas in our patients, indications for surgery and the possibility of treatment. frequency and characteristics of rare thyroid tumors. METHOD: Retrospective study of 1044 patient operated for malignant thyroid tumor. RESULTS: From 1995 to may 2003. We operated upon 15 patients with primary thyroid lymphomas. 2 men and 13 women mean age of 50.12 years (from 22 to 74 years), also one patient of age 69 with insular thyroid cancer. Reason for surgery was thyroid tumor in all, compressive disturbances in 9, among them 4 with asphyxia. Radical total thyroidectomy was performed in 4 (26.7%), whole in others some residual tumor tissue was could not be removed in spite of thyroidectomy in 3, hemithyroidectomy in 2, tumor debulking in 5 and only open biopsy was performed in one patient. There was no operative mortality. no postoperative hypocalcaemia and no recurrent nerve palsy. Histological type of tumor was Non-Hodgkin lymphoma in 13 patients, Hodgkin disease in 2 female patients of age 22 and 24. Hashimoto thyroiditis was present in 3 patients. After surgery, 13 patients were treated with chemotherapy, one patient died one month after the operation and one patient refused chemotherapy. Follow-up data are available for 9 patients and the mean follow-up period was 20 months (1-48 months). Three patients died after a month, 2 and 3 years after surgery. Six patients are without local relapse. In one patient who refused chemotherapy, a year after thyroid surgery, resection of large intestine was performed because of lymphoma of the colon. CONCLUSION: Malignant thyroid lymphomas are rare. They present with rapidly growing thyroid tumor, compression and asphyxia. Surgery is only temporarily effective and it is necessary to start with chemo-radiotherapy as soon as possible. Rare forms of thyroid cancer have to be histologically recognised in order to choose the best way of treatment.

[Surgical treatment of recurrent thyroid carcinoma]. / Hirursko lecenje recidiva karcinoma stitaste zlezde.

UNLABELLED: Recurrent thyroid tumors are much less frequent but more aggressive than primary tumors. The aim is to find out their characteristics, aggressiveness and the possibility of radical surgical excision as well as the frequency of complications. METHOD AND MATERIAL: Retrospective study on 69 patients operated for recurrent thyroid tumors. RESULTS: Recurrent tumors were found in 42 patients with papillary, 11 with follicular (8 with Hurthle), 9 with medullary and 7 with anaplastic thyroid tumors. Relapse in thyroid bed on dominant side had 41 patients (59.4%), relapse on the opposite side we found in 19 patients (27.5%) and relapse in lymph nodes outside of thyroid bed in 37 patients (53.6%). In 33/69 patients, the first procedure was incomplete (reduction in 5, partial resection in 19, hemithyroidectomy in 9). The second procedure was incomplete in 14, near total thyroidectomy in 2, total thyroidectomy in 33 and dissection of lymph nodes in 33, among them in 20 with the operation in thyroid bed. Pre-operative recurrent nerve palsy had 2 patients and transitional recurrent nerve palsy occurred after second procedure in 2 patients. Among 33 patients after thyroidectomy for recurrent tumor, postoperative hypoparathyroidism occurred in 8 (24.2%), of whom in 2 permanent (6%). In the group of 54 patients with recurrent differentiated thyroid cancer, radioiodine therapy after first operation had received only 7 patients (13%). CONCLUSION: The main causes of thyroid cancer relapse are incomplete first procedure and aggressiveness of cancer. It is not always possible to excise the complete recurrent tumor. After surgery for papillary cancer, radioiodine therapy is seldom used.

Electrophysiological correlates of recollecting faces of known and unknown individuals.

We recorded brain potentials from healthy human subjects during a recognition test in order to monitor neural processing associated with face recollection. Subjects first attempted to memorize 40 faces; half were accompanied by a voice simulating that person speaking (e.g., "I'm Jimmy and I was a roadie for the Grateful Dead") and half were presented in silence. In the test phase, subjects attempted to discriminate both types of old faces (i.e., "named" and "unnamed" faces) from new faces. Recognition averaged 87% correct for named faces, 74% correct for unnamed faces, and 91% correct for new faces. Potentials to old faces were more positive than those to new faces from 300 to 600 ms after face onset. For named faces, the old-new ERP difference was observed at anterior and posterior scalp locations. For unnamed faces, the old-new ERP difference was observed only at posterior scalp locations. Results from a prior experiment suggest that these effects do not reflect perceptual priming of faces. The posterior portion of the old-new ERP difference was thus interpreted as a neural correlate of retrieval of visual face information and the anterior portion as an indication of retrieval of person-specific semantic information.

Brain waves following remembered faces index conscious recollection.

At a glance, one can often determine whether a face belongs to a known individual. To investigate brain mechanisms underlying this memory feat, we recorded EEG signals time-locked to face presentations. In the study phase, 40 unknown faces were presented, 20 of which were accompanied by a voice simulating that person speaking. Instructions were to remember the faces with spoken biographical information (R-faces) and to forget the others (F-faces). In the test phase, famous and non-famous faces were presented in a visually degraded manner. Subjects made two-choice fame judgments and priming was observed in the form of faster and more accurate responses for old than for new non-famous faces. Priming did not differ between R-faces and F-faces. In a second experiment, faces were not degraded at test and behavioral responses were made only when faces were presented twice in immediate succession. Brain potentials elicited 300 to 900 ms after stimulus onset from frontal and parieto-occipital scalp regions were larger for R-faces than for F-faces. Recognition tested later was more accurate for R-faces than for F-faces. Because the study-phase manipulation influenced recognition but not priming, we conclude that this procedure succeeded in isolating neural correlates of recollective processing from more automatic uses of face memory as indexed by priming.